Healthcare Provider Details

I. General information

NPI: 1780323014
Provider Name (Legal Business Name): ALLYSSA NICHOLE NEWSOME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5558 CALIFORNIA AVE STE 340
BAKERSFIELD CA
93309-0710
US

IV. Provider business mailing address

5558 CALIFORNIA AVE STE 340
BAKERSFIELD CA
93309-0710
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-1577
  • Fax:
Mailing address:
  • Phone: 661-326-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: